验证复苏后良好结局评分预测中国人群中院内心搏骤停预后的临床价值研究

Validation the clinical value of good outcome following attempted resuscitation scores in Chinese populations in predicting the prognosis of in-hospital cardiac arrest

目的验证复苏后良好结局评分(GO-FAR)在中国人群中预测院内心搏骤停(IHCA)患者神经功能状态的临床价值。方法回顾分析自贡市第四人民医院2020年1月1日至12月31日入院且发生IHCA患者的临床资料。以格拉斯哥-匹兹堡脑功能评分(CPC)1分作为终点指标,根据GO-FAR评分四分位数将研究对象分为GO-FAR评分≤0分组、1~8分组、9~20分组和≥21分组4组,以GO-FAR评分≤0分组为参照组,计算其余3组与该组比较出现终点指标的优势比(OR),绘制受试者工作特征曲线(ROC曲线),评估GO-FAR评分对良好神经功能预后的预测价值,绘制校正曲线进行Hosmer-Lemeshow检验,分析GO-FAR评分预测良好神经功能预后的校准度。结果共230例IHCA患者纳入研究,男性130例,年龄74(65,81)岁,其中23例(10.0%)神经功能预后良好。各组间年龄及入院时神经功能完好、急性脑卒中、恶性肿瘤、脓毒症、非心脏疾病入院、肝功能不全、低血压、肾功能不全或透析、呼吸衰竭、肺炎患者比例等GO-FAR相关变量比较差异均有统计学意义(均P<0.05)。以GO-FAR评分≤0分组为参考组,GO-FAR评分1~8分组、9~20分组和≥21分组出现良好神经功能预后的OR值分别为0.54〔95%可信区间(95%CI)为0.17~1.53,P=0.250〕、0.17(95%CI为0.02~0.67,P=0.009)、0.25(95%CI为0.05~0.85,P=0.025)。GO-FAR评分预测IHCA患者良好神经功能预后的ROC曲线下面积(AUC)为0.653(95%CI为0.529~0.777,P=0.015),Hosmer-Lemeshow检验P=0.311,提示预测值与真实值之间无明显差异。结论GO-FAR评分可以应用于中国人群预测IHCA患者的神经功能预后,帮助临床医生预测心肺复苏(CPR)预后,并为患者或家属提出关键性治疗措施的建议。

Objective To verify the clinical value of the good outcome following attempted resuscitation(GO-FAR)score in predicting the neurological status of patients with in-hospital cardiac arrest(IHCA)in the Chinese population.Methods The clinical data of patients with IHCA who were admitted to the Zigong Fourth People's Hospital from January 1 to December 31,2020 were retrospectively analyzed.Used Glasgow-Pittsburgh cerebral performance category(CPC)score 1 point as the end point,the subjects were divided into 4 groups according to the score:≤0 group,1-8 group,9-20 group and≥21 group.Taken the group which GO-FAR score≤0 as the reference group,the odds ratio(OR)of the other three groups compared with this group was calculated.The receiver operator characteristic curve(ROC curve)was performed to evaluate the predictive value of the GO-FAR score in favorable neurological outcome.A calibration curve was drawn for the Hosmer-Lemeshow test to analyze the degree of calibration of the GO-FAR score for predicting good neurological outcome.Results A total of 230 IHCA patients were enrolled in the study,including 130 males,aged 74(65,81)years old,and 23 case(10.0%)had good neurological prognosis.There were statistically significant differences in GO-FAR-related variables,including age,a normal neurological function on admitted,acute stroke,metastatic cancer,septicemia,medical noncardiac admission,hepatic insufficiency,hypotension,renal insufficiency or dialysis,respiratory insufficiency,pneumonia,etc(all P<0.05).Taken the GO-FAR score≤0 group as the reference group,the OR values of good neurological prognosis in the GO-FAR score 1-8 group were 0.54[95%confidence interval(95%CI)was 0.17-1.53,P=0.250],9-20 group were 0.17(95%CI was 0.02-0.67,P=0.009)and≥21 group were 0.25(95%CI was 0.05-0.85,P=0.025).The area under the ROC curve(AUC)of the GO-FAR score for predicting favorable neurological outcome in IHCA patients was 0.653(95%CI was 0.529-0.777,P=0.015)and there was no significant difference in Hosmer-Lemeshow test(P=0.311).All these suggested that there was no significant difference between the predicted value and the actual value.Conclusions GO-FAR score can be applied to predict neurological prognosis of IHCA patients in Chinese population.It can help clinicians to predict the prognosis of cardio-pulmonary resuscitation(CPR)and propose critical recommendations in treatment for these patients or their families.